PEDIATRICS Vol. 108 No. 5 November 2001, pp. 1099-1102

Maternal Epidural Use and Neonatal Sepsis Evaluation in Afebrile Mothers

Received Aug 21, 2000; accepted Apr 23, 2001.

Laura Goetzl^*, Amy Cohen, Fredric Frigoletto Jr^§, Steven A. Ringer, Janet M. Lang^¶, and Ellice Lieberman

From the ^* Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; and Department of Obstetrics and Gynecology,  Brigham and Women's Hospital and ^§ Massachusetts General Hospital, and  Joint Program in Neonatology (Brigham and Women's Hospital, Children's Hospital, Beth Israel Deaconess Medical Center), Harvard Medical School, and ^¶ Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, Massachusetts.

Objective.  Epidural use has been associated with a higher rate of neonatal sepsis evaluation. Epidural-related fever explains some of the increase but not the excess of neonatal sepsis evaluations in afebrile women

Methods.  We studied 1109 women who had singleton term pregnancies and who presented in spontaneous labor and were afebrile during labor (<100.4°F). Neonatal sepsis evaluation generally was performed on the basis of the presence of 1 major or 2 minor criteria. Major criteria included rupture of membranes for >24 hours or sustained fetal heart rate of >160 beats per minute. Minor criteria included a maternal temperature of 99.6°F to 100.4°F, rupture of membranes for 12 to 24 hours, maternal admission white blood cell count of >15 000 cells/mL³, or an Apgar score of <7 at 5 minutes.

Results.  Infants of afebrile women with epidural analgesia were more likely to be evaluated for sepsis than infants of women without epidural (20.4% vs 8.9%), although not more likely to have neonatal sepsis. An increased risk of sepsis evaluation persisted in regression analysis (odds ratio: 3.1; 95% confidence interval: 2.0, 4.7) after controlling for confounders and was not explained by longer labors with epidural. Women with epidural were significantly more likely to have major and minor criteria for sepsis evaluation, including fetal tachycardia (4.4% vs 0.4%), rupture of membranes for >24 hours (6.2% vs 3.4%), low-grade fever of 99.6°F to 100.4°F (24.3% vs 5.2%), and rupture of membranes for 12 to 24 hours (21.4% vs 5.2%) than women without epidural.

Conclusions.  Epidural analgesia is associated with increased rates of major and minor criteria for neonatal sepsis evaluations in afebrile women.  Key words:  epidural analgesia, pregnancy, labor, neonatal sepsis evaluation.

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